IB/99-1

International Brief

U.S. Department of Commerce

Economics and Statistics Administration
BUREAU OF THE CENSUS

by Thomas McDevitt

IB/99-1 Issued March 1999

Peru, one of Latin Americas largest nations, is home to over 26 million people. Perus demographic profile reflects dramatic declines in fertility and mortality since the mid-1970s. The countrys crude birth rate has been reduced by over one-fourth of its 1975 level; its crude death rate, by half. As a result, Perus population is increasingly concentrated in the labor force age range (ages 15 to 64). During the coming 20 years, the ratio of dependent-age population1 to working age population will decrease by over one-fifth of its 1998 level. Within the country, regional and urban-rural variations in fertility and mortality are pronounced. For instance, infant mortality is three times higher in rural areas than in Lima, the capital2; the total fertility rate (TFR), twice as high. Demographic variations reflect disparities in wealth, resources, and availability of government services. Access to maternal health care and family planning services, like other health care services, continues to be significantly better for urban than for rural couples. Current government policy seeks to correct this situation.

Peruvian Demography Reflects Subnational Social and Economic Disparities Latin Americas fifth largest nation has historically been, and continues to be, divided along linguistic and class lines. Lima, the national capital, is the apex of the hierarchy and smaller settlements and rural areas are at its base. The 70 percent of the Peruvian population living in urban areas have higher incomes, on average, and more access to resources, government services, and other amenities than do rural residents. For example, according to the 1996 Demographic and Health Survey (DHS) report (ENDES 1996), over 90 percent of urban households have electricity; less than one-fifth of rural households do (Table 2.9). Similarly, only 6 percent of females ages 6 and above living in urban places have no education, but 24 percent of rural females have no formal schooling (ENDES 1996: Table 2.6). The percentage of females with at least a secondary education

is 57 percent in urban areas and 16 percent in rural areas. Lima differs markedly from the rest of the country not only in terms of its industry and labor market, its educational offerings and the availability of services, but also in terms of a series of demographic and health indicators. For example, infant and child mortality rates are much lower in Lima than in the rest of the country. Child mortality in Lima is about onefourth the level in other urban areas and one-eighth the level prevailing in rural areas (box). One-fourth of Peruvian children were malnourished in 1996, and again the problem varied with residence. In Lima, 10 percent of children under age 5 were classified as malnourished. That figure was 20 percent in other urban areas and 40 percent in rural areas (ENDES 1996: Table 9.8). Urban residents also tend to enjoy better health care coverage than rural residents. In 1996, over 80 percent of urban women in need of prenatal care received such care

Demographic Differentials in Peru: Infant Mortality, Child Mortality, and Fertility

Percent of population 1993 30 70 29 Infant mortality rate 1986-96 71 35 23 Child mortality rate1 1986-96 31 12 4 Total fertility rate 1993-96 5.6 2.8 2.5

Area Rural .......................................... Urban2 ....................................... Lima ..........................................

1 2

1 Dependent age groups are defined to include youth (ages 0 to 14) and the elderly (ages 65 and over). 2 Throughout this report, Lima refers to the Lima metropolitan area.

Child mortality (ages 1 to 4) is the probability of dying between exact ages 1 and 5. 2,000 or more inhabitants. Forty-one percent of Perus population lives in urban areas other than Lima. Sources: INEI 1993 and ENDES 1996.

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IB/99-1 Figure 1.

from a trained health professional, but fewer than half of rural mothers did (ENDES 1996: Table 8.2). Similarly, 4 out of 5 urban births but only 1 out of 5 rural births were attended by a doctor or nurse (Endes 1996: Table 8.8). Perus Demographic Transition Peru has been quite successful in lowering mortality. Since 1975, life expectancy at birth has increased from 57 years to nearly 70 years, fueled in part by a rapid fall in infant and child mortality. Infant mortality has declined from an estimated 105 infant deaths per 1,000 live births in 1975 to 41 today (Table 1). Over the same period, the number of births women have on average (the total fertility rate (TFR)) has fallen from 5 to 3. Fertility is declining throughout Peru, albeit faster in urban areas than in rural areas. Between the 1977/78 World Fertility Survey and the 1996 DHS, urban fertility fell by nearly 40 percent, to a TFR of 2.8 children per woman. During the same time period, rural fertility fell by about 25 percent, to 5.6 children per woman (ENDES 1991/92: Table 3.3; ENDES 1996: Table 3.1). Perus rate of natural increase has also declined from around 2.6 percent per year in 1975 to about 2.1 percent in 1998. If present trends continue, Perus population will grow by over one-third of its present sizefrom 26 million persons today to nearly 37 million personsby the year 2020. During the same time frame, Perus age structure will become increasingly older and increasingly concentrated in the prime economically productive age range (Table 1). By 2020, the working age population (persons ages 15-64) will be over half again as large as today, and the number of elderly will have doubled, while the under-15 age group will have increased only slightly (Figure 1). Largely as a result of the growth of the working age population relative to the under-15 population,

Population of Peru by Age and Sex: 1998 and 2020

1998 2020 80+ 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 2,000 Male Female

1,500

1,000

500

0 Thousands

500

1,000

1,500

2,000

Source: U.S. Bureau of the Census, International Data Base.

Figure 2.

Changes in Contraceptive Use and Method Mix Over Past 20 Years

(Percent of married women ages 15 to 49) Modern 19.9% Traditional 21.4% Nonusers 58.7% 1977/78 1986 Modern 23.0% Traditional 22.8% Nonusers 54.2% 1996 Modern 41.3% Traditional 22.9% Nonusers 35.8%

Source: U.S. Bureau of the Census, International Data Base; and ENDES 1996.

Perus dependency ratio will fall from 67 percent to just 52 percent over the coming 2 decades (Table 1). Contraceptive Use The fertility decline central to Perus demographic transition has been made possible by an increase in the use of family planning and a shift to more effective methods of contraception. Contraceptive prevalence has risen from about 41 percent of married women in the late 1970s to 46 percent in 1986 and to 64 percent in 1996 (Table 2). Adoption of more efficient, modern methods of contraception since 1986 accounts for nearly all of this increase (Figure 2). However, data from the 1996 DHS show distinct differences in usage

patterns. Rural and less educated women have lower contraceptive prevalence rates than other women, and they rely more heavily on less effective, traditional methods (Figure 3). High Risk Pregnancies, Unwanted Fertility and Unmet Need for Contraception Although the practice of family planning is growing, the unmet need for contraception is still high. Indeed, over half of all pregnancies that went to term in 1996 were considered high risk (ENDES: Table 7.5). Some of these pregnancies could have been avoided with family planning. Apart from the matter of health risk, there is evidence that women were bearing an average of about

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Figure 3.

The Government Responds

Sterilization Other modern Traditional

Contraceptive Method Mix by User Characteristics: 1996

Residence Lima Other large urban Other urban Rural Female educational attainment None Primary Secondary Higher 0 10 20 30 40 50 60

70

80

Percent of married women ages 15-49

Source: ENDES 1996.

One of the challenges facing Peru during the coming years will be that of expanding access to family planning and other reproductive health services for poor, less educated, and rural underserved populations. The government recently reversed a policy, in place since 1996, of setting targets for sterilizations. Its stated commitment now is to a goal of ensuring that women have information and counseling to achieve their individual desires with respect to spacing and number of children. References

Figure 4.

Unmet Need for Family Planning: 1996

Residence Lima Other urban Rural Female educational attainment None Primary Secondary Higher 0 5 10 15 20 25 Percent of married women ages 15-49
Source: ENDES 1996.

Spacing Limiting

Instituto Nacional de Estadstica e Informtica (INEI). 1993. Peru: Crecimiento y Distribucin de la Poblacin (Anlisis de Cifras Preliminares). Censos Nacionales 1993 series. Lima. Instituto Nacional de Estadstica e Informtica and Macro International, Inc. 1997. Encuesta Demogrfica y de Salud Familiar 1996. (ENDES 1996). Columbia, MD. Instituto Nacional de Estadstica e Informtica, Associacion Benefica PRISMA, and Macro International, Inc. 1992. Encuesta Demogrfica y de Salud Familiar 1991/1992. (ENDES 1991/1992). Columbia, MD. The International Programs Center (IPC) collects, assesses, and analyzes population and related statistics from all countries. Based on these data, IPC produces the demographic estimates and projections used in this series of reports. This report was prepared with the support of the U.S. Agency for International Development. More detailed information is available from the International Programs Center, Population Division, Bureau of the Census, Washington, D.C. 20233-8860.

one child more than the number they desired in 1996 (ENDES 1996: Tables 3.1, 6.9, 7.5). One in 8 married women said she wanted to limit or space future births, but was not using a method of family planning in 1996. The percentage of married women in this situation, deemed to have unmet need for family planning, was higher in rural areas (20 percent) than in urban areas (9 percent). The percentage was also higher for less educated women than for women with a secondary education (Figure 4). Part of the problem stems from limited access to family planning services. In 1991, median travel time to the nearest source of a modern method of contraception

was 16 minutes for urban residents compared with about an hour for rural residents (ENDES 1991/92: Table 4.12). Information on the use of induced abortion provides additional evidence of unmet need. Peruvian health officials have been cited as indicating that as many as 1 in every 3 pregnancies in the country is terminated through induced abortion (The Washington Post, 11/10/95:A24). And abortion is considered one of the leading causes of maternal mortality in Peru. The government and proponents of its population policy say that greater access to contraceptive services is required to reduce both unwanted pregnancies and abortions.

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IB/99-1

Table 1.

Table 2.

Population Indicators for Peru: 1990 to 2020

(Population in thousands, gures may not add to totals because of rounding) Indicator POPULATION Total country . . . . . . . 21,989 26,111 27,136 32,122 Urban . . . . . . . . . . . . . 15,150 18,802 19,747 24,503 Rural. . . . . . . . . . . . . . 6,839 7,308 7,389 7,619 Male, Total Country All ages . . . . . . . . . . . 11,068 13,132 13,645 16,133 0 to 14 . . . . . . . . . . . . 4,319 4,741 4,834 4,999 15 to 44 . . . . . . . . . . . 5,074 6,207 6,469 7,795 15 to 49 . . . . . . . . . . . 5,493 6,757 7,063 8,635 15 to 64 . . . . . . . . . . . 6,366 7,857 8,230 10,288 65+ . . . . . . . . . . . . . . . 383 534 581 846 75+ . . . . . . . . . . . . . . . 111 161 176 285 Female, Total Country All ages . . . . . . . . . . . 10,921 12,979 13,491 15,989 0 to 14 . . . . . . . . . . . . 4,186 4,595 4,682 4,827 15 to 44 . . . . . . . . . . . 4,960 6,083 6,343 7,651 15 to 49 . . . . . . . . . . . 5,377 6,630 6,935 8,491 15 to 64 . . . . . . . . . . . 6,278 7,752 8,123 10,172 65+ . . . . . . . . . . . . . . 457 632 686 990 75+ . . . . . . . . . . . . . . . 147 217 238 379 Married Females Ages 15 to 20 to 25 to 30 to 35 to 40 to 45 to 15 to 49 . . . . . . 19 . . . . . . . . . . . 24 . . . . . . . . . . . 29 . . . . . . . . . . . 34 . . . . . . . . . . . 39 . . . . . . . . . . . 44 . . . . . . . . . . . 49 . . . . . . . . . . . 3,099 138 493 630 603 501 401 334 73.9 65.7 63.6 68.0 3,902 160 579 757 773 656 538 439 67.3 70.0 67.7 72.3 4,112 163 602 789 808 702 574 475 65.9 70.8 68.5 73.2 5,144 187 686 936 996 888 778 673 57.0 74.4 72.0 76.9 6,051 189 752 1,081 1,142 1,061 966 859 51.6 77.1 74.6 79.7 18,396 4,849 8,650 9,721 12,105 1,443 568 18,508 5,038 8,828 9,899 12,236 1,234 429 36,904 29,276 7,628 1990 1998 2000 2010 2020

Contraceptive Prevalence Among Currently Married Women 15 to 49 Years of Age by Method

Percentage of married women currently using specic methods for selected years 1977/78 All . . . . . . . . . . . . . Pill . . . . . . . . . . . . . Condom . . . . . . . . IUD . . . . . . . . . . . . Female sterilization. . . . . Other modern . . . Traditional . . . . . . 41.3 5.5 1.4 1.8 3.6 7.6 21.4 1986 45.8 6.5 0.7 7.4 6.1 2.3 22.8 Percentage of married woman currently using specic methods by residence: 1996

Method

Other 1996 Lima urban Rural 64.2 6.2 4.4 12.0 9.5 9.2 22.9 71.6 7.9 8.0 17.1 9.6 8.2 20.7 69.2 6.5 4.1 13.0 12.6 9.3 23.7 51.2 4.3 1.4 6.1 5.4 10.3 23.7

Sources: ENDES 1996, Tables 4.4 and 4.6; and U.S. Bureau of the Census, International Programs Center, International Data Base.

Table 3.

Other Proximate Determinants of Fertility

CHILDLESS WOMEN: 1996 Percent of currently married women ages 45 to 49 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DURATION OF POSTPARTUM INFECUNDABILITY: 1996 Median Months By Residence Country. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Lima . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other larger centers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Remaining urban . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Rural . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Median Months By Educational Attainment None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Primary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Secondary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Higher . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Source: ENDES, 1996, Table 5.12. 15.3 11.5 8.9 6.3 9.6 8.2 7.9 8.0 12.1 4.6

DEPENDENCY RATIO Both sexes . . . . . . . . Both sexes . . . . . . . . Male . . . . . . . . . . . . . . Female . . . . . . . . . . . . LIFE EXPECTANCY AT BIRTH (years)

INFANT MORTALITY RATE (per 1,000 births) Both sexes . . . . . . . . Male . . . . . . . . . . . . . . Female . . . . . . . . . . . . 57.8 64.3 51.0 40.8 45.9 35.5 37.1 41.7 32.4 23.6 26.3 20.6 15.2 17.0 13.4

UNDER-FIVE MORTALITY RATE (per 1,000 births) Both sexes . . . . . . . . Male . . . . . . . . . . . . . . Female . . . . . . . . . . . . 81.0 87.1 74.6 54.7 59.6 49.6 49.1 53.6 44.4 29.7 32.8 26.5 18.5 20.5 16.4

Table 4.

Age-Specic Fertility Rates

(Per 1,000 women) Age 1975 93 238 265 220 174 70 16 5.4 1986 83 191 204 165 126 66 13 4.2 1993 79 184 175 147 110 51 8 3.8 1998 67 167 165 129 90 39 7 3.3 2000 62 160 162 122 81 34 6 3.1

MATERNAL MORTALITY RATIO 1989-1996 (per 100,000 births) Total . . . . . . . . . . . . . . TOTAL FERTILITY RATE Per woman . . . . . . . . 4.1 3.3 3.1 2.6 2.3 265

Note: Dependency ratio is the number of persons under age 15 and ages 65 and above per 100 persons ages 15 to 64 years. Sources: U.S. Bureau of the Census, International Programs Center, International Data Base; and ENDES 1996, Table 7.12.

15 to 19. . . . . . . . . . . . . . 20 to 24. . . . . . . . . . . . . . 25 to 29. . . . . . . . . . . . . . 30 to 34. . . . . . . . . . . . . . 35 to 39. . . . . . . . . . . . . . 40 to 44. . . . . . . . . . . . . . 45 to 49. . . . . . . . . . . . . . Total fertility rate . . . . .

Source: U.S. Bureau of the Census, International Programs Center, International Data Base.

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